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Hello OSWAPIC IPs, 

I recently had a question from our new Endoscopy department manager about the routine use of simethicone mixed with sterile water that is used during endoscopy procedures to reduce bubbles. The new manager came from another system where this practice had been phased out many years ago due to infection prevention concerns and potential for damage to the scope with repeated use of diluted simethicone. 

I am wondering if other endoscopy departments are still routinely using simethicone, and if so, do you have guidelines that you would be willing to share? It looks like there is a fair bit of research and recommendations to avoid this practice, however there is language in the IFUs to allow for this practice per facility guidelines. 

Thank you, 

Stephanie Klippenstein

Here is what was rolled out for Providence:

All endoscope manufacturers have distanced themselves from any liability associated with the use of simethicone or other non-water soluble products. In 2018 we received a letter from Olympus warning us of the risks of simethicone adhering to our scope channels, contributing to biofilm formation, and microbial growth. We learned from the Stanford and Cori Ofstead that simethicone is retained in the scope channel, even when used in low concentrations. This retention supports biofilm formation and microbial growth. Cori Ofstead's study revealed simethicone is retained simethicone retention in the scope of channels of 69 fully reprocessed scopes from 4 different hospitals and >50% of those scopes tested positive for microbial cultures. She issued a "call to action" to all infection preventionists to determine whether these products are used in their institutions and evaluate methods for removing them. Water solubility is essential because simethicone, regardless of how it is administered, results in a buildup of residue in our scope channels, Dimethicone, an ingredient in simethicone, is used in products specifically to retain moisture and is used to treat headlice because it prevents water evaporation and downs the lice. Dry scope channels are essential to avoid biofilm formation, and microbial growth.

It is our responsibility to advocate for our patient's safety and mitigate the risk of biofilm formation and microbial growth in our scopes. We recommend transitioning to a product that is water-soluble, eliminates bubbles to allow for visualization of the GI tract, and is in alignment with the scope manufacturer's recommendations. Through IRB approved research, we have learned that GI ease meets these criteria.

I hope this helps!

Nick Vollstedt MS, CIC

Senior Manager Infection Prevention

Providence Oregon - West Service Area